DHS Has Updated the Background Information Disclosure Form

From DHS, Division of Quality Assurance

 The Department of Health Services, Division of Quality Assurance (DQA) has revised the Background Information Disclosure (BID) form F-82064. License applicants, employees, contractors and non-client residents must complete the BID form as part of the required caregiver background check process.  

The Caregiver Law, under Wis. Stat. § 50.065 require regulated facilities/entities to complete two types of caregiver background checks:

  • Those completed by employers on their employees and contractors at the time of hire.
  • Those completed by DQA as part of the licensure process for a DQA regulated health care facility on license applicants/ license holders, some principal officers, and non-client residents.

Entities must maintain the background check documents for each employee or contractor. The records must be readily available to DQA staff upon request. Refer to the Caregiver Background Check Process webpage for complete information regarding the employee background check process and the license holder background check process.

Please email the Office of Caregiver Quality if you have any questions.

DHS Offers Tools To Prevent Social Media Caregiver Misconduct

From DHS, DQA, Office of Caregiver Quality

The following resources have been developed for use by facilities to raise awareness among staff in order to prevent occurrences of caregiver misconduct through the use of handheld devices:

  • Snapping Pics Puts Your Job At Risk (Livestream, help) –This video depicts a scenario of a caregiver who is contemplating taking a picture of a peacefully sleeping resident to share with her co-worker. It highlights the potential consequences of this action, including being suspended from her job and being placed on the Caregiver Misconduct Registry.
  • Animated Infographic (Livestream, help) –This two minute informational video highlights what happens when a possible incident of caregiver misconduct occurs. DHS recommends this video be used as a follow up to the Snapping Pics Puts Your Job At Risk video.
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Direct Care Workforce Payments Arriving to Providers


WALA has heard from some of membership that the MCOs are starting to send out the Family Care Direct Care Workforce payments. These are the first quarter’s payments from the $60.8 Million we advocated for in the 2017-2019 Wisconsin State budget. These payments may come in check form with little information attached – so please watch your mailboxes over the next few weeks. Each MCO seems to be handling the payments differently. Providers making calculations have stated that the checks roughly 4% of the reimbursement amount from Family Care.

Please make sure that you are accurately documenting how these funds have been disbursed (wage increases, bonuses, PTO, or payroll taxes) and to whom they were given. Although aggregate amounts are needed for the attestation (link below) more detail should be internally documented in case an audit happens in the future.

The quarter 1 provider attestation and survey site is now live at the following site:


FAQs about the process is also available at https://www.dhs.wisconsin.gov/medicaid/ltc-workforce-funding-faq.htm

June 2018 Meeting Notice

The June meeting of the Fort Adult Care Consortium will take place on Tuesday, June 12th, at 10:00 AM at the Dwight Foster Public Library, 209 Merchant Street in Fort Atkinson, WI. Before the organizational meeting which starts at 11:00 AM (download the Agenda here), Rainbow Hospice will be providing a “Hospice 101” overview for us. Snacks will be provided. PRE-REGISTRATION IS REQUIRED and can be easily done here. Check out the flyer for the seminar for more information. Certificates for 1 contact hour of Continuing Education will be available for attendees.

March 2018 Meeting Notice

The March meeting of the Fort Adult Care Consortium will take place on Tuesday, March 13th, at 10:00 AM at the Dwight Foster Public Library, 209 Merchant Street in Fort Atkinson, WI.  The Agenda (download here) includes a discussion of the City’s draft proposal of a licensing ordinance (download here) for supportive care facilities in the city, as well as ongoing discussions about 2018 training opportunities, .   Please come to share your views on the matter

Hospice 101

St. Croix Hospice is sponsoring “Hospice 101” training on June 12, 2018.  The training will be held at Dwight Foster Public Library, 209 Merchant St., Fort Atkinson.  Continuing Ed certificates will be available upon completion.  There is no cost for this training.  Pre-registration is required as seating is limited.